NHeLP's Capital Communique
May 3, 2005
This is one of a series of periodic reports from the National Health Law Program's Washington office, reporting briefly on recent and forthcoming developments relating to federal policy of interest to NHeLP advocates and friends. We always appreciate your feedback and comments, which can be emailed to Mara Youdelman.
See the website for updates and information on NHeLP publications.
SUBJECTS COVERED
Medicaid/Budget Update Confirmation of Judges Medicare Prescription Drugs/Low-Income Beneficiaries Access to Drugs Bill Introduced Welfare and Child Care Extension Federal Factoid Resources Congressional Schedule
THE BUDGET AND MEDICAID
On April 28, the U.S. House of Representatives and the U.S. Senate passed the FY 2006 budget resolution, a measure that sets funding amounts for broad categories such as Health. The bill does not require the president's signature.
The agreement directs authorizing committees to make funding cuts by September 16 that could result in Medicaid cuts of at least $10 billion, a number that could go higher if the House Energy and Commerce Committee does not cut other areas or programs to meet the instruction to trim $14.7 billion from programs under its jurisdiction.
Leading up to the agreement, there had been discussion about creating a new Medicaid commission to recommend program changes, but the final budget resolution does not include any funding for or language addressing a commission. At this time, there is no agreement on the purpose, scope or composition of a commission or who would appoint its members.
HHS Secretary Michael Leavitt said on April 29, "I look forward to working on the formation of a fair, balanced, and open commission to address the challenges facing Medicaid and to produce reforms the Administration, Congress and governors can embrace. I urge Congress to continue pursuing bipartisan Medicaid reform. The time to act on Medicaid is now."
The budget resolution also assumes enactment of $106 billion in new tax cuts, directing that $70 billion in tax cuts be passed this year. The federal deficit was $412 billion in 2004 and is expected to increase to $427 billion by September 2005.
Reaching agreement on how much to cut Medicaid became a major impediment to completing action on a budget resolution. President Bush proposed reducing Medicaid spending by $14 billion over five years. The House budget included $20 billion in cuts. The Senate initially proposed about $15 billion over five years, but, led by Senators Gordon Smith (R-OR) and Jeff Bingaman (D-NM), the Senate voted 51 to 49 to delete those cuts in exchange for a Medicaid study commission.
The budget resolution sets overall spending limits for broad functional categories and subsequent legislation must not exceed these spending limits. Making actual cuts will require changing current law. Any legislation reported by Congressional committees to carry out the resolution's directives, called "reconciliation legislation," moves under special rules. This means that the anticipated Medicaid reductions, like $70 billion of the proposed new tax cuts, will not be subject to a Senate filibuster, and therefore will only require 51 votes to pass.
Medicaid cuts under discussion include $5 billion from changing how pharmacies are reimbursed for drugs, $1.5 billion from tightening up on transfer of assets used to qualify for nursing home care, and $2 billion by allowing higher beneficiary copayments. It is not clear whether this last number only includes savings achieved by having recipients pay more for their care, or whether it also reflects the large number of people who would be forced out of the program altogether, assuming the increased copayments have the same effect as those imposed in earlier Medicaid experiments.
For Medicaid, the Senate Finance and the House Energy and Commerce Committees will be developing proposals in the next few months. They could report bills by early August or as late as mid-September. The House and Senate are expected to take up reconciliation bills shortly after they are reported from the committees.
POSSIBLE ACTION: Those wishing to do so could urge members of Congress to oppose cuts in Medicaid or policies that reduce Medicaid coverage or eligibility.
MEDICARE DRUG COVERAGE
The Center for Medicare and Medicaid Services (CMS) has started distributing $31.7 million to state Medicare counseling programs to help beneficiaries understand eligibility requirements and the steps involved in choosing a plan. These funds will go to State Health Insurance Counseling Programs, or SHIPS, which exist in every state. CMS plans to work with Area Agencies on Aging and the Social Security Administration (SSA) to identify and enroll low-income beneficiaries and with the National Governors Association to help "dual eligible's," people eligible for both Medicare and Medicaid. The Medicare prescription drug law, enacted in 2003, shifts drug coverage from Medicaid to Medicare for dual eligible's on January 1, 2006.
SSA has sent the first of 20 million applications to low-income people in 42 ZIP codes in 21 states who might qualify for the new drug benefit. Some advocates for low-income people are concerned that the seven-page form is so complex that few people will respond. There is also concern that SSA does not plan to inform those whom it finds ineligible for the subsidy available to low-income beneficiaries that they can apply to their state's Medicaid program for the various Medicare Savings Programs (MSP). In some states, those programs have more liberal eligibility criteria than SSA is using for the low-income subsidy, and qualifying for MSP automatically qualifies a person for the low-income subsidy, even if SSA has already denied their application.
For information, including an implementation schedule, visit CMS website and Medicare Implementation.
JUDGES
The Senate Judiciary Committee on a party-line vote has approved the nominations of Texas Supreme Court Justice Priscilla Owen and California Supreme Court Justice Janice Rogers Brown for federal appeals court positions. The philosophies and decisions of these two nominees, which are viewed by most Democrats as extreme, have stymied their approval in past Congresses. Consideration of these nominations by the full Senate could provoke a historic showdown over that body's filibuster rules.
It now appears likely that the Senate Republican leadership will force a confrontation over Senate rules, which require 60 votes to stop a filibuster. Filibustering is a long-established practice in the Senate in which one senator can "talk an issue to death" unless 60 votes exist to move it forward. The filibuster is usually used by the minority party, since if a party is in the majority it can prevent an up or down vote on a nominee simply by bottling the nomination up in committee. The previous administration accused Senate Republicans of refusing to report President Bill Clinton's nominees from the Judiciary Committee to the full Senate.
There are now 55 Republicans and 45 Democrats in the Senate and all Democrats are reported to be opposing the nominations of Judges Owens and Brown. With the cooperation of Vice-President Dick Cheney, the presiding officer of the Senate, Majority Leader Senator Bill Frist (R-TN), may try to end the use of filibusters for judicial nominations and allow confirmation by a simple majority of Senators. This strategy has been called the "nuclear option" by both parties and the "constitutional option" by some. This step would be unprecedented. In response, Minority Leader Senator Harry Reid (D-NV) has said that Democrats will employ a range of procedural tactics to bring almost all Senate business to a halt if the 60-vote rule is changed.
See the website for a table showing all nominations and their status.
POSSIBLE ACTION: Those wishing to do so could urge senators to oppose elimination of the filibuster, a tool that insures that a small majority does not ride roughshod over the concerns of a large minority.
WELFARE AND CHILD CARE EXTENSION
Both houses of Congress voted to extend the current Temporary Assistance to Needy Families (TANF) program until June 30, 2005. President Bush signed the bill on March 25. This temporary extension of the program is the ninth since its enactment in 1996. The bill, H. R. 1160, keeps current law in place. These short-term extensions maintain 2002 funding levels to states for welfare and child care.
It is not clear at this time when or even if Congress will pass a comprehensive TANF reauthorization bill. On March 15, 2005, the House Ways and Means Subcommittee on Human Resources reported a TANF reauthorization bill (H.R. 240) that would increase work requirements and offer "marriage strengthening" grants to states. The bill was reported on a party line vote of 7 to 4. The Senate reauthorization bill would extend Transitional Medical Assistance for five years; the House bill, for one year.
ACCESS TO DRUGS
Senators Frank Lautenberg (D-NJ) and Rep. Carolyn Maloney introduced the Access to Legal Pharmaceuticals Act (S. 809 and H. R. 1652), bills to address the practice of pharmacists refusing to dispense medications that violate their religious or moral beliefs.
The bill does not require a pharmacist to fill every prescription, but requires another pharmacist in the same pharmacy to fill the prescription if one pharmacist has religious or moral objections. Some states have enacted laws allowing pharmacists to refuse to fill prescriptions because of their personal beliefs. These bills would override state laws. The authors say the intent is largely to assure access to contraceptives.
CONGRESSIONAL SCHEDULE
The U. S. Senate will not be in session from May 2 to 6. The Senate and House of Representatives will have state and district work periods from May 30 to June 3.
POSSIBLE ACTION: Recesses and district work periods often offer opportunities to meet with members of Congress in their state or district offices to discuss issues.
FEDERAL FACTOID
"The infant mortality rate in the U.S. has declined from 26 per 1,000 in 1960 to seven per 1,000 in 2003, while the mortality rate among those younger than five years has declined from 30 per 1,000 to eight per 1,000 during these years. . . In 1960, 11 countries had infant mortality rates lower than the United States. In 2003, 40 had infant and child mortality rates lower than or equal to those in the United States." Source: Journal of the American Medical Association, April 13, 2005
RESOURCES
The Agency of Health Care Research and Quality has a series of consumer-friendly papers on how to get and assess health care quality. The materials include "Quick Tips: When Talking to Your Doctor," "Improving Health Care Quality: A Guide for Patients and Families," and "Ways You Can Help Your Family Prevent Medical Errors."
You can learn about environmental hazards in your neighborhood by putting in your zip code. These maps, on the U. S. Environmental Protection Agency's website, show you, for example, hazardous waste sites, toxic releases and air emissions.
Brendan McTaggart
Communications Director
National Health Law Program
1101 14th St NW, Suite 405
Washington, DC 20005
Ph (202) 289-7661
Fx (202) 289-7724
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